A fulminant form of monkeypox discovered

An international team of scientists has discovered a "killing" form of monkeypox, which preys on men with advanced HIV and low defenses, reaching a mortality of 15%.

While the usual pattern usually includes a few mild vesicles that clear up in a few weeks, the aggressive form causes skin ulcers that keep growing and even spread to the lungs, eyes and intestines, explains one of the main culprits. of the study, the doctor Oriol Mitjà, from the Germans Trias i Pujol Hospital, in Barcelona.

“Some of these kids asked for sedation because they said they couldn't take the pain anymore.

The lesions are equivalent to those of a major burn,” alerts the researcher.

Since the current outbreak began in May 2022, some 85,000 cases of monkeypox have been reported worldwide, the vast majority in gay or bisexual men (98%, in a study of half a thousand cases in fifteen weeks). countries).

The main route of transmission is close physical contact during sexual intercourse.

The population groups most at risk, explains Mitjà, are men living with HIV and those who take daily antiretroviral drugs precisely to avoid HIV infections during sex without a condom, the so-called pre-exposure prophylaxis (PrEP).

"The sociologists' hypothesis is that these two populations have higher risk sexual practices, with a greater number of partners, with less protection and with more use of drugs during sex," explains Mitjà.

The World Health Organization decided in November to rename the disease as mpox, to avoid "racist and stigmatizing comments", but proposed to keep the classic term for one year to avoid confusion.

The ailment has been called monkeypox for more than half a century, after its discovery in Asiatic macaques in a scientific laboratory in Denmark.

The first known human case was that of a child from the Democratic Republic of the Congo in 1970.

Almost half of the 85,000 people with mpox detected last year were also living with HIV, the virus that causes AIDS.

If not treated with antiretroviral drugs, HIV destroys CD4 lymphocytes, a type of white blood cell that protects people against infection.

The fulminant cases of monkeypox now described are concentrated in men with very advanced HIV, below the threshold of 200 lymphocytes per cubic millimeter of blood.

With the defenses so low by HIV, the second virus is unstoppable.

“We don't call it withering because of its speed, but because it doesn't stop.

Go on and on and on.

No matter how many interventions you make, the virus continues to progress ”, warns Mitjà.

The study, published Tuesday in

medical journal , analyzes 382 cases of monkeypox in people with advanced HIV, all of them men, except 10 transgender women and 4 cisgender women.

The heartbreaking photographs included in the investigation show men with an average age of 35, with a body full of lesions with necrosis, especially in the mouth, genitals and anus.

It is not a new variant of the virus, but the same pathogen causes a different disease in these people.

The work includes 27 of the 60 known deaths in the outbreak last year.

The 27 had very low defenses.

“Many of these boys were not treated with antiretrovirals against HIV.

Many are from Latin America, where there is not universal access to these drugs.

And others were not even diagnosed ”, laments Mitjà.

73% of the patients included in her study received treatment in American countries: Argentina, Brazil, Canada, Chile, Ecuador, Mexico, Peru and the United States.

The rest were treated in a dozen European countries, including Spain, in addition to another six patients in Nigeria.

9% did not know they had HIV.

Of those who knew, one in three were not taking antiretroviral therapy to prevent AIDS.

There are no antivirals for mpox in any Latin American country

Oriol Mitjà, doctor

The authors of the study urge the World Health Organization to include this fulminating form of mpox on the list of AIDS-defining illnesses, a list of 14 infections that behave differently and dangerously in people with advanced HIV.

British doctor Chloe Orkin, co-lead author of the research, urges her colleagues to be very vigilant: “Everyone with mpox should be tested for HIV.

And all people with HIV and mpox should take a test to measure their defenses”.

More than a hundred of the 382 patients analyzed had to be hospitalized.

In the case of the deceased, the previous admission barely lasted 47 days on average.

Orkin, from Queen Mary University of London, points out that the aggressive form of monkeypox kills 30% of people with HIV with exceptionally low defenses, below 100 CD4 lymphocytes per cubic millimeter of blood.

The doctor calls for prioritizing people with HIV when receiving vaccines and antiviral treatments against monkeypox.

“It is imperative that vaccines and antivirals are made accessible throughout the world and this requires greater global cooperation,” she proclaims.

The doctor Meg Doherty, director of the HIV, Hepatitis and Sexually Transmitted Infections programs of the World Health Organization, confirms to EL PAÍS that her institution is going to study whether it includes this fulminant form of monkeypox in the criteria for diagnose advanced HIV.

“This recent case series makes a very compelling argument that people living with HIV, and with a CD4 count below 200 cells per cubic millimeter, are at high risk of severe disease and death from mpox, and that the disseminated infection behaves like other opportunistic infections,” explains Doherty.

The expert asks to guarantee access to treatments, vaccines and diagnostic tests for the people who need them most.

The doctor Oriol Mitjà directs the section of sexually transmitted infections and neglected skin diseases at the Germans Trias Hospital and the Fight Against Infections Foundation.

In his Barcelona center they have seen 250 cases of mpox, but only three of them in people with advanced HIV and low defenses.

One of the cases had very serious complications.

Mitjà regrets that the drugs are not available globally: “There are many countries where there is still no free or easy access to antiretrovirals against HIV, such as the United States and Mexico.

Regarding mpox antivirals, they are only available in first world countries.

There are no antivirals for mpox in any Latin American country.”

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